C102. Transjugular venous access for permanent pacemaker as an approach when there was no other choice : A Case Report

Abstract Background When conventional veins are inaccessible, the transjugular Seldinger technique for permanent pacemaker (PPM) implantation could be used as the last resort. Case Description An 80-years-old woman had wound skin extrusion and infection at the site of left deltopectoral pocket of pe...

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Bibliographic Details
Published in:European heart journal supplements 2021-11, Vol.23 (Supplement_F)
Main Authors: Fathoni, E, Rizal, A
Format: Article
Language:English
Online Access:Get full text
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Summary:Abstract Background When conventional veins are inaccessible, the transjugular Seldinger technique for permanent pacemaker (PPM) implantation could be used as the last resort. Case Description An 80-years-old woman had wound skin extrusion and infection at the site of left deltopectoral pocket of permanent pacemaker. After removing the PPM lead generator and debriding the wound, a single chamber PPM was implanted in right hemithorax after temporary pacemaker backup. There was no access in the left area and proximal vein stenosis was found following an early attempt to reach the right subclavian vein and cut-down surgical procedure. Other stenosis were also found at the upper right veins by venography. A single chamber PPM was implanted utilizing the Seldinger technique to puncture the internal jugular vein without surgical cut-down and dissection for tunneling the lead from right jugular area to deltopectoral pocket. Lead test came out acceptable: R wave of 12 mV, Slew >4 V/s current >25 mA, impedance 688 Ω and threshold of 0.87V. There were no pneumothorax and other complications followed. Discussion Venous occlusion could be found in patients undergoing pacemaker insertion. For some cases, the internal jugular vein works as an alternative access for PPM insertion without surgical cut down. Percutaneous access to the internal jugular vein is safer, and the risk of lead fractures is reduced.
ISSN:1520-765X
1554-2815
DOI:10.1093/eurheartjsupp/suab124.101